At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for aiding HCSC's IFM risk adjustment operational management and analytics activities and functions. Operational areas include but are not limited to data management, data submissions, reject remediation, data reconciliation, data reporting and analytics, performance management, vendor management, as well as, interfacing with federal regulatory agencies if/when applicable. Job Responsibilities: Acts as lead in various activities such as risk adjustment encounter data collection, processing, submission, small/medium/large projects, report generation, and data reconciliation efforts ensuring that data is processed and submitted according to State and/or CMS guidelines and requirements. Conducts business analysis and recommends solutions to leadership Analyze encounter data to identify trends, and conduct root cause analysis; develop improvement plans, organize cross-functional teams and develop high-quality output for internal and external constituents to address identified issues Provides guidance and training to other staff members as needed Monitors vendor performance and guiding them through issues, areas for improvement, and priorities Create reports, insights and analytics in support of the business. Create specifications for reports and analysis based on business needs; possibly providing consultation to users and working on cross-functional teams to address business issues. Produce datasets and reports for analysis using system reporting tools; possibly performing research and assisting in analyzing data related to the division's strategic initiatives and broader research needs. Partners with vendors, team members, provider groups, etc. to ensure all CMS and/or State guidelines for risk adjustment data capture and contractual service level agreements are met. Serves as a Subject Matter Expert for other departments, providers, projects, and committees Performs any other job-related duties as assigned. Required Job Qualifications: <ul> <li>Bachelors or Advanced degree (or 4 years' experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration </li><li>3-5 years' experience working in Healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related operations. </li><li>Experienced in query design/development (e.g. SAS, SQL, etc.) and/or relational database understanding </li><li>Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter file formats </li><li>Experience working with healthcare data specific to risk adjustment and/or related functions </li><li>Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership </li><li>Strong interpersonal, organizational, communication, and workflow skills </li><li>Willingness and ability to travel approximately up to 25 </li></ul>Preferred Job Qualifications: <ul> <li>Experience with risk adjustment encounter file preparation and remediation (e.g. 837 5010 files, RAPS returns/submission files, EDPS MAO-002, 277CA, and/or 999 file, MAO-004, or EDGE files etc. </li><li>Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus </li><li>Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities </li><li>Experience with databases as well as interpretation and manipulation of related healthcare data (e.g. claims, enrollment data etc.) </li><li>Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage </li><li>Knowledge of HCC coding, risk adjustment </li></ul> This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $53,500.00 - $118,100.00

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary

This position is responsible for aiding HCSC's IFM risk adjustment operational management and analytics activities and functions. Operational areas include but are not limited to data management, data submissions, reject remediation, data reconciliation, data reporting and analytics, performance management, vendor management, as well as, interfacing with federal regulatory agencies if/when applicable.

Job Responsibilities:
• Acts as lead in various activities such as risk adjustment encounter data collection, processing, submission, small/medium/large projects, report generation, and data reconciliation efforts ensuring that data is processed and submitted according to State and/or CMS guidelines and requirements.

• Conducts business analysis and recommends solutions to leadership

• Analyze encounter data to identify trends, and conduct root cause analysis; develop improvement plans, organize cross-functional teams and develop high-quality output for internal and external constituents to address identified issues

• Provides guidance and training to other staff members as needed

• Monitors vendor performance and guiding them through issues, areas for improvement, and priorities

• Create reports, insights and analytics in support of the business.

• Create specifications for reports and analysis based on business needs; possibly providing consultation to users and working on cross-functional teams to address business issues.

• Produce datasets and reports for analysis using system reporting tools; possibly performing research and assisting in analyzing data related to the division's strategic initiatives and broader research needs.

• Partners with vendors, team members, provider groups, etc. to ensure all CMS and/or State guidelines for risk adjustment data capture and contractual service level agreements are met.

• Serves as a Subject Matter Expert for other departments, providers, projects, and committees

• Performs any other job-related duties as assigned.

Required Job Qualifications:

Bachelors or Advanced degree (or 4 years' experience in lieu of degree) in Business Administration, Finance, Statistics, Healthcare Administration
3-5 years' experience working in Healthcare industry in Medicaid and/or Medicare Encounter operations, risk adjustment or related operations.
Experienced in query design/development (e.g. SAS, SQL, etc.) and/or relational database understanding
Knowledge of Medicare and/or Medicaid Encounter Data System and understanding of 837-5010 and/or other standard encounter file formats
Experience working with healthcare data specific to risk adjustment and/or related functions
Proficient/advanced in MS Office (Excel, PowerPoint, Access, etc.) to derive effective presentations & exhibits for leadership
Strong interpersonal, organizational, communication, and workflow skills
Willingness and ability to travel approximately up to 25
Preferred Job Qualifications:     Experience with risk adjustment encounter file preparation and remediation (e.g. 837 5010 files, RAPS returns/submission files, EDPS MAO-002, 277CA, and/or 999 file, MAO-004, or EDGE files etc.
Experience with Medicare and/or Medicaid risk adjustment encounter management, reporting and requirements from either a payer or vendor a big plus
Knowledge of and experience in Medicare and/or Medicaid risk adjustment functions, regulations, and other related activities
Experience with databases as well as interpretation and manipulation of related healthcare data (e.g. claims, enrollment data etc.)
Knowledge of encounters within other lines of business including Exchange/ACA, Medicaid, and/or Medicare Advantage
Knowledge of HCC coding, risk adjustment

This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range
$53,500.00 - $118,100.00

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This position is responsible for analyzing/coordinating requirements; defining project scope and requirements, translating business requirements into use cases, activity or flow diagrams, and participating in project management activities. Performing business research to identify gaps between current state and future vision; conducting interviews with customers and enterprise experts to provide insight based on business research and analysis. Maintaining all documentation on the business project; and working closely with the business architects and interpreting and documenting functional/non-functional requirements. This position may also support the review of various demands and evaluate the portfolio and set scope for future delivery meeting market and customer demands. Required Job Qualifications: *Bachelor in Technology or Business Administration with 3 years experience in project management, business process analysis, or operations/systems analysis OR 5 years experience in project management, method analysis, or operations/systems analysis. *Clear and concise verbal and written communication skills. *PC proficiency to include but not limited to MS Office. *Experience with multiple full lifecycle software projects with strong understanding of how each phase fits into the overall lifecycle. *Experience in using requirements management tools, such as IBM's RequisitePro, RequisiteWeb, or DOORS. *Experience with business modeling tools (i.e. Visio) ad various methodologies/frameworks like CMMI, RUP, Six Sigma, etc. *Solid Facilitation, Presentation and Leadership skills Preferred Job Qualifications: *Experience with the end-to-end Blue Chip claims processing system. *Experience in healthcare claims processing. *Major System Development requirements: *Familiarity with business process design and aid the high-level business process design efforts with assistance of the stakeholders and end users. *Work with Business Architects and organization change manager to ensure organizational change communication to enable business process implementation. This position does not provide Visa sponsorship. This is a flex/hybrid position (requires 3 days in office; 2 days work from home). #LI-SM1 #LI-HYBRID INDM *CA Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$53,500.00 - $118,100.00

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This Position Is Responsible For Leading The Development Of Functional And Non-Functional Business Requirements; Working With The Business Solutions Lead To Understand Business Strategy And Translate Into Product Requirement. Required Job Qualifications: *Bachelor's degree and 4 years Information Technology, business analysis specific experience OR Technical Certification and/or College Courses and 6 year Information Technology, business analysis specific experience OR 8 years Information Technology, business analysis specific experience. *1 year experience leading project. *Knowledge of system architecture and application portfolio. *Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise). *Ability to simplify & standardize complex concepts and/or processes. *Business acumen. *Project management skills. *Requirements definition and management. *SDLC, Iterative, Agile, OWF, and /or Scrum development. *Problem solving and/or analytical thinking. *Possess ability to manage workload, and manage multiple priorities, as applicable. *Written and verbal communications Preferred Job Qualifications: *Bachelor's degree in computer science, Business Administration, or Information Technology. *Business process management and modeling. *BA Certification *Experience working in healthcare industry Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$80,700.00 - $145,700.00

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Job Summary This Position Is Responsible For Leading The Development Of Functional And Non-Functional Business Requirements; Working With The Business Solutions Lead To Understand Business Strategy And Translate Into Product Requirement.   Required Job Qualifications:
*Bachelor's degree and 4 years Information Technology, business analysis specific experience OR Technical Certification and/or College Courses and 6 year Information Technology, business analysis specific experience OR 8 years Information Technology, business analysis specific experience.
*1 year experience leading project.
*Knowledge of system architecture and application portfolio.
*Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise).
*Ability to simplify & standardize complex concepts and/or processes.
*Business acumen.
*Project management skills.
*Requirements definition and management.
*SDLC, Iterative, Agile, OWF, and /or Scrum development.
*Problem solving and/or analytical thinking.
*Possess ability to manage workload, and manage multiple priorities, as applicable.
*Written and verbal communications

Preferred Job Qualifications:
*Bachelor's degree in computer science, Business Administration, or Information Technology.
*Business process management and modeling.
*BA Certification
*Experience working in healthcare industry
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:  We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range$80,700.00 - $145,700.00

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary This Position Is Responsible For Leading The Development Of Functional And Non-Functional Business Requirements; Working With The Business Solutions Lead To Understand Business Strategy And Translate Into Product Requirement. Required Job Qualifications: Bachelor's degree and 4 years Information Technology, business analysis specific experience OR Technical Certification and/or College Courses and 6 year Information Technology, business analysis specific experience OR 8 years Information Technology, business analysis specific experience. 1 year experience leading project. Knowledge of system architecture and application portfolio. Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise). Ability to simplify & standardize complex concepts and/or processes. Business acumen. Project management skills. Requirements definition and management. SDLC, Iterative, Agile, OWF, and /or Scrum development. Problem solving and/or analytical thinking. Possess ability to manage workload, and manage multiple priorities, as applicable. Written and verbal communications Preferred Job Qualifications: Bachelor's degree in computer science, Business Administration, or Information Technology. Business process management and modeling. BA Certification Experience working in healthcare industry Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process HCSC Employment Statement: We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range$80,700.00 - $145,700.00

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Business Analyst Health Care Service Corporation Jobs

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